Thomas A. Ban: Carl Wernicke’s classification of psychoses with special reference to mania and depression

CARL WERNICKE’S CLASSIFICATION OF PSYCHOSES WITH SPECIAL REFERENCE TO MANIA AND MELANCHOLIA

Thomas A. Ban

Stimulated by Sir Charles Bell’s (1811) discovery and François Magendie’s (1822) recognition of the importance of the “reflex arc” that links sensory input with motor output in the functioning of the nervous system (spinal cord), Griesinger (1843) was first to perceive mental activity as “reflex” activity. He was also the first to describe, in 1843, “psychic reflex actions” (psychische Reflexactionen).

Carl Wernicke (1848-1905), the professor of neurology and psychiatry in Breslau, Germany (1890-1904), adopted Griesinger’s view that mental activity is ”reflex” activity, and perceived “psychoses,” as “hypo (deficit)-functioning,” “hyper (excess)-functioning”, or “para (distorted)-functioning” of one or more components (paths, phases) of the “psychic reflex” (Ban 2013; Franzek 1990; Wernicke 2000). Accordingly, he attributed “psychoses” displayed by “anaesthesia”, “hyperaesthesia” or “paraesthesia” to malfunctioning of “psychosensory” brain areas; “psychoses” displayed by “afunction”, “hyperfunction” or “parafunction” to malfunctioning of “intrapsychic”(trans-cortical) brain areas, and “psychoses” displayed by “akinesia”, “hyperkinesia” or “parakinesia” to malfunctionjng of “psychomotor” brain areas (Wernicke 1899).

Wernicke was operating within the frame of reference of contemporary “associationism”. He conceptualized the brain as an associative organ, consciousness as a product of associative activity and the “soul”, as the sum of all possible associations (Menninger, Mayman and Pruyser 1968). He divided consciousness into consciousness of the outside world (“allopsyche”), consciousness of one’s body (“somatopsyche”) and consciousness of one’s self-individuality (”autopsyhe”) and classified psychoses into “allopsychoses”, characterized by disorientation in the representation of the outside world, “somatopsychoses”, characterized by disorientation in the representation of one’s own body and “autopsychoses”, characterized by disorientation in the representation of one’s own self-individuality. In diagnosing and classifying, Wernicke employed his “elementary symptom“ approach (Ban 2015; Krahl 1910; Wernicke 1893) ) and, in 1900, in his Fundamentals (Grundriss) of Psychiatry, he classified “delirium tremens”, “Korsakoff psychosis” and “presbyophrenia” as “allopsychoses”; “anxiety psychoses” and “hypohondriacal psychoses” as “somatopsychoses”; and “mania” and “melancholia” as “autopsychoses”.

In describing “mania”, Wernicke emphasized the presence of “ideas of grandeur”, and in describing “melancholia”, he emphasized” ideas of indignity”. He saw “manic” and “melancholic” psychoses as independent from each other, but recognized that they frequently occur in the same patient. He also noted that “mania” was “more recurrent” with “shortening intervals between episodes” than “melancholia”, and that the prognosis of ”mania” was worse than of “melancholia” (Angst and Grobler 2015; Menninger, Mayman and Pruyser 1968; Wernicke1896).